nursing at the heart of public health
TRANSCRIPT
Nursing at the heart of public health:
Understanding the value and contribution of nurses and midwives to
public health in the UK
www.nurses4ph.org.uk Helen DonovanProfessional Lead for Public Health Nursing, RCN, UK
Nigel DaviesProfessor of Healthcare Workforce Development, University of Bedfordshire
Public Health Nursing where have we come from and where next…
• The Public Health challenge• The RCN work on understanding the value of
public health nursing• Celebrating success
Davies S, Winpenny E, Ball S, Fowler T, Rubin J, Nolte E (2014)For debate: a new wave in public health improvement. Lancet. DOI: 10.1016/S0140-6736(13)62341-7
Public Health – past present and future
Social Movement for health
Context and background RCN - Need to embrace PH and RCN
stakeholder event UK governments' health policies MECC - public health as everyone’s business to
supporting behaviour change. PHE - Chief Nursing Office work; ‘All our Health’
Framework for Personalised Care and Population Health for Nurses, Midwives, Health Visitors and Allied Health Professionals.
Lord Willis: Shape of Caring - ‘Raising the Bar’ NMC – nurse revalidation PHSKF - review
All OUR Health (AOH) is a ‘Call to Action’ to healthcare professionals (HCPs) individually and collectively, to contribute to NHS England’s Five Year Forward View to:
– close the health and wellbeing gap– contribute to radical upgrade in prevention and public health – develop a social movement for health
All O R Health Programme?
AOH provides an opportunity to• Complement structural and large scale sustainability and transformation with
professional mobilisation• Provide solutions to HCPs concerns re developing ‘health promoting practice’• Reduce time for adoption of preventative practice• Promote engagement with practitioners leaders and educators changing
practice now and for the future
‘All Our Health’ - www.gov.uk/government/publications/all-our-health-about-the-framework/all-our-health-about-the-framework Public Health Outcomes Framework: www.phoutcomes.info/
Project overview A mixed methods study asking commissioners
and designers of public health services their views:
What’s happening? Development of case studies to showcase the diversity of work and roles to present nursing’s contribution to public health.
Overseen and supported by an Expert Reference Group
Study objectives and design Objectives:
To explore the perceived value and contribution of nursing to public health in the UK and to identify gaps between perceptions, expectations and need.
Study design: A mixed methods sequential explanatory design in two phases.
Methods: Phase 1: National on-line survey of commissioners, managers and
practitioners responsible for service design of public health services (response: n=219).
Phase 2: In-depth interviews (n=16) with a purposive sample of survey respondents and stakeholders. The interviews sought to illuminate the survey findings.
Key findingsThe main themes emerging from both the survey and the interviews were: Nursing involvement and the hidden nature of some
aspects of public health nursing The quality of public health nursing provision and nurses
unique local knowledge Current perceived challenges related to re-organisations
and specifically diminishing local nursing leadership.
Nursing involvement(actual vs. desired)
In all areas respondents believed nursing should be involved in public health more than it currently is.
– Notable differences (around 40% points) between desired and actual involvement in 7 areas
Housin
g
Employm
ent
Chemica
ls & P
oison
s
Radiat
ion
Emergen
cy R
espo
nse
Enviro
nmen
t hea
lth ha
zards
Commiss
ioning
0
20
40
60
80
100
Frequency of current and desired nursing involvement in public health
Always or often frequently involvedAlways or often should be involved
However – nursing involvement is often hidden• Responses to some questions in the
survey ran counter to professional knowledge
E.g. the perception that nurses were not involved in some health protection areas
• Comments in the interviews.• This was also highlighted from a
strategic perspective in relation to workforce decisions where the variety of job titles used by nurses disguise their public health roles.
“the public see nurses giving a ‘flu
vaccine but other aspects like advising someone
about alcohol consumption aren’t
recognised.”
“only specialist public health nurses can be
counted”
Skills looked for when designing PH servicesF 4 types of personal qualities and competence came out
strongly (> 50% of responses) - out of 17 themed qualities.
Local Knowledge Research and Project Management Skills Communication
• some mentioned interpersonal skills
Behavioural Characteristics• care, compassion, determination, motivation, commitment
Reasons for utilising nursing in public health servicesTop 5
Percentage of respondents identifying reasons for using or employing nurses in PH
Commissioning
Communication Skills
Local Knowledge
Competence
Care Specialist
43%
44%
46%
55%
69%
Local knowledge equips nurses to better provide public health
• Detailed understanding of the local community
• Accessibility and ability of clients and service users to approach nurses.
• Potential for fragmentation especially when services were organised functionally rather than around the client group or patient.
• Local knowledge of the invisible nature of some vulnerable client groups
“Basing people in large hubs with hot- desking
… it just doesn’t feel local enough. I’ve got a team based in
a health centre seven miles … [from] the population they work
with … They’re not there, or visible.”
Challenges• The top three challenges to commissioning care and the
nursing contribution were derived from open ended questions in the survey.
Public Health
improvement not achieved
Issues with Knowledge, training and
skills
Lack of resources
Problems with
commissioning
Diminishing Leadership• Challenges linked to diminishing nursing leadership at a local level• No longer prominent senior public health nurses;• Concerns were often linked to moves to recent re-organisation with
fears decisions about cuts would be made without the nursing contribution being understood
• The variety of service models meant nursing leadership was implicit rather than explicit in many senior nurse leader roles
“there are no public health nursing
posts at a local level above band
7”
“nurses were making headway with new programmes of study but
since changes and funding and integration this has reduced”
This contrasted with national nursing leadership in public health which was recognised in all UK countries.
Recommendations from the study The nursing profession needs to:
focus on increasing the visibility of nurses in public health by articulating the value and contribution nurses make bridging population health with individual patient care.
Educationalists need to: increase the focus on public health in all nursing education programmes.
Public health across the curricula should be mapped not only where it is directly taught but also where attendant skills are developed.
Nursing leadership: Champion at a local as well as national level to make sure nursing teams
are contributing to public health at all applicable opportunities. Ensure they are “skilled-up” to work with commissioners so meaningful
key performance indicators, service level agreements and local incentive targets (e.g. Commissioning CQUINs) are set which reflect public health nursing.
Case Studies• Criteria for inclusion was
based on:• the description of the work or
project• the nursing contribution• the outcomes and impact.
• Show-cased on line at www.nurses4PH.org.uk • Presentation materials and
some with audio interviews with practitioners and service-users.
Thank youQuestions…
Comments… Ideas?@nurses4PH
Contact details: [email protected] @HelenDon_RCN [email protected] @nigelwpdavies
Links / References to this work:Donovan, H. & Davies, N. (2016) The Value and Contribution of Nursing to Public Health in the UK. Final Report, Royal College of Nursing (published online January 2016)Davies, N. & Donovan, H. (upcoming) Exploring commissioners’ and service planners’ views of public health nursing in the UK: national survey and stakeholder analysis.Merrifield, N. (2016) More nurse involvement wanted by public health commissioners, Nursing Times, 17 FebruaryStephanie Jones-Berry, (2016) RCN calls for more nurse input into public health: Survey describes where nurses could apply their knowledge and skills to care in the community, Primary Health Care. 26, 2, 7 Public Health England (2016) All our Health: about the framework (Online) available at https://www.gov.uk/government/publications/all-our-health-about-the-framework/all-our-health-about-the-framework
www.nurses4PH.org.uk
Other referencesRCN (2012) Going upstream: nursing’s contribution to public health, London, Royal College of Nursing.Davies, S. et al (2014) For debate: a new wave in public health improvement. Lancet, 384, 1889-95 (Nov 22)